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Comments (13)

Sue :

18 Dec 2012 9:59:16am

Thanks for the discussion. Had more time been available, we might have heard more about the benefits to the baby of a Cesarean delivery - which are well-documented. WHile there is one documented adverse effect which Prof Dahlen mentioned (but did not explain) - Transient Tachpynoea of the Newborn (TTN) is a benign condition (literally a transient episode of rapid breathing)- which leads to observation in NICU but no long-term consequences. Prof Dahlen did not mention the lower rate of injury to the baby in Cesarean section - and most importantly a much lower rate of intra-partum hypoxia (shortage of oxygen) and of physical injury (such as nerve and bone injury sustained while being compressed through the birth canal in vaginal delivery).

THis discussion should not be about the ideology of "natural" - it should be about the health outcome of the baby. Isn't that why women go through birth?

Comadrona :

Not to disrespect your personal experience, Lynn, but such an injury from birth is quite rare. Also, many such injuries are actually caused by not being patient and trying to hurry birth along.

Powerful drugs are routinely given which limit the mother's ability to feel how to push in tune with her body's messages, and which restrict her mobility so she is forced to deliver on her back (which has been demonstrated to be THE most likely position in which to sustain sizeable tears and to require instruments which, themselves, cause damage).

In a naturally starting labour, where the mother is undrugged and moving around, the likelihood of tears and other damage is greatly reduced. So many times we hear stories that go: "if I hadn't had a C/section I and my baby would have died". Almost every time, when you get the whole picture, you find out that it started with an induction or other unwarranted intervention.

Sue :

20 Dec 2012 11:21:54am

Comadrona - full fistulas are rare but vaginal injury, including cervical tears and haemorrhage, are obviously more common during vaginal birth.

More importantly, however, injury to the baby is much more common in vaginal birth - both physical injury - commonly swollen head, bruising, also nerve injuries and occasionally fractures - but also systemic injuries like shortage of oxygen.

The problem with avoiding the medical augmentation of labour is that prolonged labour - especially if the membranes are ruptured - carries its own risks to both mother and baby.

Comadrona :

18 Dec 2012 11:57:28am

This is terribly complex - I could write a thesis. But the main problems which I see as a midwife are these: Private Obs book far too many patients to attend all their labours and natural births, partly because they have huge expenses, including exorbitant malpractice insurance. They also want their private life, so it is much easier to start planting seeds of doubt in a woman's mind at the beginning of their "care" relationship (care usually consists of a 4 minute visit with no knowledgeable hands touching the woman, just a machine which is known to be more inaccurate for sizing the baby the farther along in the pregnancy it is used). This results in the suggestion that the woman's pelvis is too small and/or the baby is too big (diagnosed by their office ultrasound) and sets the stage for an early induction which often fails because the baby and mother are not ready,and then they are off to theatre for their C/section. It is very easy to research the "cascade of intervention" so I won't elaborate here. I suppose this wouldn't matter if C/section were the benign procedure it is touted to be. But there are plenty of risks to both mother and babe, up to and including death. Once again there is plenty of research which supports vaginal birth as the preferable route. Birth has been turned into a process line in a factory where women are induced and augmented to speed up labour and midwives and doctors are run off their feet because of the high-level care needed for all these women on dangerous medications. As a result of well women now needing post-surgical nursing (as opposed to mothercraft and midwifery care), being anaemic from blood loss, being loaded up with narcotics for pain relief which go through to the baby, breast-feeding often gets off to a poor start and mothers give up in despair. This has documented ill-effects on their confidence in their parenting but also long-term implications for the health of their children. I have met countless women who have been assured by Obs that a Caesarean is quick, painless and easy - well, it is for the doctor. I have yet to meet an Ob who truly educated a patient as to the realities. Not long ago I met a woman who was told that if she dared to attempt a vaginal birth she would end up with an obstetric fistula (his exact words). This is the sort of rare injury which happens to third-world women who have no medical care and are days away from the nearest hospital - he told her a blatant lie. Her baby was exactly the right size for dates and she was a fit, healthy young woman. All she needed was some education regarding the positioning of her baby in utero for birth, and some reassurance about birthing, which I gave her, after which her baby changed position and engaged in her pelvis. Unfortunately he scared her so badly, she went ahead with the planned C/section.

danah :

18 Dec 2012 9:48:04pm

"I have yet to meet an Ob who truly educated a patient as to the realities." Surely not? As an Obstetrician I spend a lot of time trying to explain to women the risks of Caesarean Section. I know I am not the only one. It is the women themselves who come to me requesting such major surgery rather than experiencing labour.

Sue :

Axelle :

18 Dec 2012 1:30:14pm

What about women who want to have their baby naturally, and have no medical reason to prevent them? Are they going to feel guilty of not putting the baby's best interests first? Have nature and evolution made a mistake by not designing us to give birth through our stomachs? If a caesarian is medically necessary, then of course it is right and saves lives and suffering. But I don't want to see this argument of elective caesarians leading into attitudes and ideas that could divide women from one another.

Rebecca :

18 Dec 2012 1:31:36pm

I agree with Sue, there needs to be a shift away from the obsession that it is a lifestyle choice. If there is going to be an analysis it should include the statistics for birth related injury, etc for both mother and child to see if the increase in intervention has led to a decrease in risk to the baby and to the mum. And a comparison of these between the public and private sector. This should also include the ongoing health costs of those who are injured (or worse) and need further care at a later date or even for life.I was also personally offended by John Doyle's flippant remark that a c-section is less painful. It is major abdominal surgery and hurts like hell. It just hurts a different part of your body.

Pauline Hull :

May I tell you about a book on the subject that was published this year:It's called 'Choosing a Cesarean, A Natural Birth Plan' and is published by Prometheus Books in New York.

In ths book, we cover the risks of planning a cesarean birth in great detail, but also the risks associated with a trial of labor. There are birth stories from women all around the world and there are whole chapters on the politics of birth and the picture worldwide.

It's enjoyed very good comments from high profile reviewers and is aimed at anyone interested in the subject of cesarean birth - from pregnant women through to medical professionals.

Dorothy :

20 Dec 2012 3:52:55pm

My OB encouraged me to have a vaginal birth, but given the trauma, the effects of which I still suffer from today nineteen years later, I so wish that I had asked for a cs. None of the women in my family seem to deliver easily without enormous difficulty and as I feared the result was the same for me. I often had to feed my child standing up, as sitting dowm was just too painful, even with a ring cushion. There is so much pressure to have a vb however, that I felt that my request for an elective cs would be refused. When my OB saw what I went through, I think that he was sorry that we hadn't taken this option also. The only good part of the story is that my son and I both survived.